Provider Demographics
NPI:1386420636
Name:PONCE, TAYLOR MICHELLE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MICHELLE
Last Name:PONCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 SPARKS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6152
Mailing Address - Country:US
Mailing Address - Phone:307-369-4710
Mailing Address - Fax:307-222-0279
Practice Address - Street 1:3207 SPARKS RD STE 200
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-6152
Practice Address - Country:US
Practice Address - Phone:307-369-4710
Practice Address - Fax:307-222-0279
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WY12041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator